Impact of the COVID-19 Pandemic on Pediatric Elbow Fractures: Marked Change in Management and Resource Utilization, Without a Change in Incidence

Abstract

Background: Elbow fractures are the most common pediatric fractures requiring operative treatment. Although recent reports have suggested that the COVID-19 pandemic has markedly reduced the incidence of pediatric fractures, no study has specifically evaluated the impact on pediatric elbow fractures. This study aimed to evaluate changes in the incidence, severity, and resource utilization for managing pediatric elbow fractures during the COVID-19 pandemic, compared with prepandemic years. Methods: A prepandemic (2007 to 2017) cohort and a COVID-19 pandemic period (March 2020 to March 2021) cohort of pediatric elbow injuries from a single tertiary hospital were retrospectively examined and compared. Exclusion criteria included outside treatment or lack of diagnosis by an orthopedist. Presentation information, injury patterns, transport, and treatment requirements were collected. Results: Although the incidence of pediatric elbow fractures and rate of neurovascular injury were comparable, seasonal patterns were not sustained and the rate of fracture displacement was found to be significantly elevated in the COVID-19 period compared with nonpandemic years. Likewise, marked changes to where patients first presented (emergency department vs. Clinic), how the patients were transported, and the distance traveled for care were observed. Specifically, patients were more likely to present to the clinic, were more likely to self-transport instead of using emergency medical service transportation, and traveled a greater distance for care, on average. Aligning with these changes, the resources utilized for the treatment of pediatric elbow fracture markedly changed during the COVID-19 period. This study found that there was an increase in the overall number of surgeries performed, the total operative time required to treat elbow fractures, and the number of patients requiring admission during the COVID-19 period. Conclusions: These data provide a contrasting viewpoint to prior reports, illustrating that the incidence of elbow fractures remained consistent during the COVID-19 period, whereas the operative volume and need for hospital admission increased compared with years prior. Furthermore, this study demonstrated how the COVID-19 pandemic altered the interface between pediatric patients with elbow fractures and our institution regarding the location of presentation and transportation. Level of Evidence: Level III—retrospective cohort study.

Changes in pediatric fracture patterns presenting to US emergency departments before, during, and after the COVID-19 pandemic

“…We noted no difference in the percentage of fractures in boys compared to girls throughout the entire study period ( Fig. 1 D), as observed by many others [ [2] , [3] , [4] , [5] , [6] , 13 , 14 ].…”

“…Some studies noted an increase in the percentage of operative fractures during the pandemic [ 5 , 6 ], while others did not [ 2 , 13 ]. The ratio of ED discharged/not discharged was not available in two studies [ 2 , 13 ].…”

“…Changes were seen in health care, including orthopaedics. The initial effect of the pandemic on pediatric fractures was noted early on by Bram et al [ 2 ] and later by others [ [3] , [4] , [5] , [6] ]. Bram et al [ 2 ] noted a 2.5-fold decrease in the volume of fractures presenting to the Children's Hospital of Philadelphia during the pandemic.…”

“…The incidence of femoral and tibial shaft fractures increased, going from 1.9 % to 4 % of all fractures for the femoral shaft and 3.4 %–6.6 % for the tibial shaft. Schultz et al [ 6 ] from Tennessee found that the incidence of elbow fractures remained constant during the pandemic. However, patients were more likely to present to the clinic compared to the ED, were more likely to be self-transported compared to ambulance transportation, and traveled longer distances to obtain care.…”

Fractures in Children Due to Firearm Activity

“…The data from 1993 through 2020 was downloaded from the ICPSR website; however, due to changes in injury patterns associated with the COVID pandemic, those data from the year 2020 were excluded [ 27 , 28 , 29 , 30 , 31 , 32 ], including firearm injuries [ 33 , 34 , 35 ]. The data includes age, sex, race, type of firearm, the perpetrator of the injury (e.g., self, stranger, etc.…”